Laparoscopy system

ABSTRACT

A laparoscopy system for female sterilization whereby a single unit contains the power source to provide illumination, oscillatory electrical power and CO2 for a laparoscopy. CO2 gas, under pressure, is first passed into the body through a needle into the peritoneal cavity. The fallopian tubes are identified and then the laparoscope, which contains a telescope connected to a source of illumination, is inserted into the body cavity. A flexible forceps is, thereafter, inserted through the laparoscope into the body cavity. The forceps is manipulated to successively close the passage through each fallopian tube, either by means of sending electrical oscillations through the forceps to simultaneously cut, seal and cauterize each tube in turn, or by means of a specific clamp which clamps the passage shut.

United States Patent [191 Lampman et al.

[5 LAPAROSCOPY SYSTEM [75] Inventors: Russell A. Lampman, Yardley;

William R. Knepshield, Malvern, both of Pa.

[73] Assignee: KLI, Inc., Ivyland, Pa.

[22] Filed: Feb. 1, 1973 [2]] Appl. No.: 328,513

[52] US. Cl. 128/303.13, 128/4 [51] Int. Cl A61b 17/36 [58] Field ofSearch..... 128/303.13, 303.14, 303.15,

[56] References Cited UNITED STATES PATENTS 2,382,109 8/1945 Sheiffele128/4 2,828,748 4/1958 August 128/303.14 3,299,883 l/1967 Rubens 128/4OTHER PUBLICATIONS Fiber Optic Laparoscope-American Cystoscope Makers,Inc., D-l83, Feb. 1972.

The Lancet Vol. 11 of 1959, No. 7104, pages Fur-rues FLOW VOLUMEPPESSUPE FILI- FLOW SELECT INSUFFL. 4 719 EL EC rtoconaucn 710A! 28Flue": er-um rep n in 34 ILLUMINITOR 36 4 1 R L 3 4 A 50 3 o 1 46 i smnarenunnnr MIML) ca,

[451 Sept. 10, 1974 Primary ExaminerLucie l-l. Laudenslager Attorney,Agent, or Firm-Arthur A. Jacobs ABSTRACT A laparoscopy system for femalesterilization whereby a single unit contains the power source to provideillumination, oscillatory electrical power and CO for a laparoscopy. COgas, under pressure, is first passed into the body through a needle intothe peritoneal cavity. The fallopian tubes are identified and then thelap- V aroscope, which contains a telescope connected to a source ofillumination, is inserted into the body cavity. A flexible forceps is,thereafter, inserted through the laparoscope into the body cavity. Theforceps is manipulated to successively close the passage through eachfallopian tube, either by means of sending electrical oscillationsthrough the forceps to simultaneously cut, seal and cauterize each tubein turn, or by means of a specific clamp which clamps the passage 5shut.

4 Claims, 3 Drawi ng Figures smousm PATENTEU saw an 2 3 884 392LAPAROSCOPY SYSTEM This invention relates to a laparoscopy system forfemale sterilization, and it particularly relates to a system of thistype which is embodied in a single unitary assembly.

A laparoscopy system is used for female sterilization by minor surgicalmeans wherein the fallopian tubes are separated, cut and sealed.

Heretofore, in laparoscopy, it was necessary for the operator to use avariety of different surgical instruments as well as separate heatsealing means or clamps in order to complete the process. The assemblingof the various instruments and their separate use was not onlytime-consuming, but their proper use depended largely on the skill andexperience of the operator. It was also often necessary to use a varietyof make-shift instruments and apparatus which were never designed forthis specific task so that much time and effort were wasted and muchskill was needed to obtain the exact correlation of steps and the exactresults desired.

It is one object of the present invention to overcome the aforesaiddisadvantages by providing a unitary laparoscopy assembly wherein allthe elements are correlated and coactive with each other for thespecific purpose required and wherein the proper metering and indicatingdevices co-act with each other to obtain a rapid, highly coordinated andeffective result with a minimum of skill and experience.

Another object of the present invention is to provide an assembly of theaforesaid type that is relatively simple and inexpensive in constructionand which requires a minimum of maintenance.

Another object of the present invention is to provide an assembly of theaforesaid type which is compact and relatively portable.

Other objects and many of the attendant advantages of this inventionwill be readily appreciated as the same becomes better understood byreference to the following description when read in conjunction with theaccompanying drawings wherein:

FIG. 1 is a view, partly in elevation and partly in perspective of thevarious components constituting a laparoscopy device embodying thepresent invention.

FIG. 2 is an enlarged end view taken on line 22 of FIG. 1, in thepresent invention.

FIG. 3 is a schematic view of the electronic circuit utilized in thepresent invention.

Referring now in greater detail to the various figures of the drawingswherein similar reference characters refer to similar parts, there isshown a housing having a pair of fluidic indicators, 12 and 14, each ofwhich consists of a small spring-pressed piston. These indicators are ofthe type manufactured by the Micro Switch Company, Freeport, 11]., adivision of Honeywell. These indicators are operatively connectedbetween an internal tank and the patient output. The indicator 12 showsred when the pressure is below a predetermined level and the indicator14 shows red when there is no flow of CO gas.

Below the indicators 12 and 14 is a lamp 16 which indicates the COinput, being adapted to glow when the pressure in the supply (externaltank) is below a predetermined level.

Below the lamp 16 are two dials, the dial 1 8 indicating the CO volumein the internal tank, and the dial indicating the CO pressure-in the.body cavity of the patient being treated.

Below the dials 18 and 20 are three mechanical switch means indicated at22, 24 and 26 respectively. The switch 22 is a push-button device whichmechanically activates a fill valve for the CO flowing from the primary(external) supply to the internal tank when it is pushed in; the toggleswitch 24 mechanically activates or deactivates an on-off valve to allowflow of CO from the internal tank to the patient; the toggle switch 26is a high-low pressure selector which selects flow from either a high orlow pressure second stage regulator of standard construction.

The electrocoagulation activator system comprises a push-button, on-offelectrical switch 28 to activate or deactivate the electronic network, apush-button, on-of electrical switch 30 for the illuminator system, anda glow lamp 32 to indicate activation of the electrocoagulation means,this lamp being adapted to glow when the foot-pedal, hereinafterdescribed, is depressed. The push-buttons 28 and 30 also contain glowlamps which will be hereinafter described.

Below the aforementioned switches is a selector switch 34 which is usedto regulate the high frequency oscillator to set the range ofelectrocoagulation, and a fitting or adaptor 36 which is provided forthe purpose of providing illumination to the telescope through afiberoptic cable hereinafter described. Behind the fitting 36 iscontained a projection bulb, hereinafter described, which iselectrically connected to the pushbutton 30 which turns it on and off.

A groundplate 38 is adapted to be strapped to the patient by a rubberband or the like, indicated at 39, and this groundplate is connected at40 to the electronic network. A cable-type forceps 42 is provided with ajack 44 that is connected by a cable to a connector 46 connected intothe oscillator circuit of the electronic network. A footpedal 48 isconnected by a cable to the plug 50 connected to the oscillator circuit.A CO outlet 52 is connected to a valve 54 which has an outlet 56 that isselectively connected to either the housing 58 of a Verees needle 60 ora trocar sleeve 62. The sleeve 62 is adapted to hold a trocar 64 whichis insertable through the sleeve and held in place by a spring-pressedplunger 66. The sleeve 62 is also provided with an inlet tube 68 whichis adapted to receive the outlet 56 of the valve housing 54.

The laparoscope is indicated generally at 70, and comprises a tubularhousing 72 having a neck portion 74 and a connector portion 76 which isconnected through an optionally provided knurled focusing knob 78 to aneyepiece 80. A tubular inlet 82 extendsoutwardly from the interior ofneck portion 74 and is adapted to receive the forceps 42. The inlet 84is provided with a shut-off valve 85 similar to the valve 54. A tubularextension 84 projects outwardly from the interior of connector portion76. This extension-8400mprises a bundle of fiberoptic strands and isadapted to be connected to a light-transmitting cable 86 which is also abundle of fiberoptic strands encased in aflexible sheathing. This cable86 is connected to the adaptor 36.

The housing 72, as best seen in FIG. 2, contains an elongated tube 88,adapted'to receive a telescope 89 (shown in FIG. 1), and an elongatedtube 90 integral and continuous with the inlet-82" and adapted toreceive the forceps 42 which is inserted through inlet 82. The

interior of the housing 72 is filled with fiberoptic material 92 aroundthe two tubes 88 and 90. The cable86 is adapted to transmit light fromthe projection bulb behind the adaptor 36 through the extension 84 intothe housing 72 to provide light for the telescope.

In operation, the valve 54 is attached to the housing 58 of the Vereesneedle 60 and the valve 54 is connected by a flexible tube to the COsupply outlet 52. The supply outlet 52 is connected to an internal tankin the housing by a low pressure hose. The internal tank is filled withCO from an external supply tank (not shown) by means of the push-buttonswitch 22 which mechanically operates a valve in the connection betweenthe external and internal tank after going through a primary stageregulator of standard construction.

The needle 60 is then injected into the peritoneal cavity of the patientand the select switch 26 is set to high, which is about 30 mm. ofmercury as set by the factory. The switch 24 is then activated to causea flow of CO into the patients peritoneal cavity at the area selected bythe operator. The needle 60 is adapted to pass through the tissue intothe desired cavity where the fallopian tubes should be situated. If thepressure reading is then maintained, at 9-12 mm. Hg pressure, as shownby dial 20, the gas flow is within the correct cavity. If it is not thecorrect cavity, the gas pressure rapidly increases and flow is slowed.In this case, the needle is then reinjected and the gas flow repeateduntil the correct cavity is found. The selector valve, operated by theselect switch 26, is then set to low (about 10 mm. of mercury) afterapproximately 2 liters of CO is passed into the peritoneal cavity.

When the pressure reading indicates that the gas is flowing into thecorrect cavity, the gas flow is halted and the needle is withdrawn. Aslight incision is then made with a scalpel just below the umbilicus,and through this incision is inserted the trocar 64 which istelescopically positioned within the sleeve 62. The valve device 54,which has been disassembled from the needle housing 58, is then coupledto the inlet 68 and the CO pressure is maintained at a constant 10 mm.of mercury. The trocar is manipulated to push between the tissue andinto the peritoneal cavity.

The trocar is then pulled out and the laparoscope 70 is inserted in itsplace. With the vlaparoscope in position, the fiberoptic cable 86 isconnected between the extension 84 and the adaptor 36 behind which iscontained the light source. The ground plate 38 is also attached to thepatient at this time.

With the laparoscope in position, the valve 85, which is normally closedto prevent escape of the gas, is opened and the forceps 42 is insertedthrough the inlet 82 and the tube 90 into the body cavity. The forcepsitself then substantially prevents escape of the gas. The pushbutton 30is pushed in to turn on the lamp behind adaptor 36. At this time the COis maintained at a constant 10 mm. mercury pressure which equalizes thepressure of the gas in the cavity, so that there is effectively no flow.The operator then peers through the eyepiece 80 and, while doing so,uses the forceps to grip a fallopian tube. With the forceps in theproper position around the fallopian tube, the operator steps on thefootpedal 48 which activates the oscillator circuit, the power output ofthe oscillator having been set by adjustment of the selector switch 34to a predetermined value. The oscillator sends its pulses through thecable 94, leading from connector 46, through the forceps 42. Thisresults in a simultaneous cutting, sealing and cauterizing of thefallopian tube by electrocoagulation. The same procedure is thenrepeated with the other fallopian tube.

Although an electrocoagulation process has been described above, it isalso possible to substitute a clip means which can'be inserted by aspecial forceps and manipulated thereby to clamp the fallopian tube,closing the passage therethrough.

The electronic control and actuating network is shown in FIG. 3. The ACinput is comprised of power input lines 102 and 104 and a ground line106. The ground line 106 is tied to the housing to prevent shock hazard.The lines 102 and 104 are placed into and out of the circuit with theprimary winding 108 of a transformer 110 by means of a double poledouble throw maintained contact illuminated pushbutton switch 112operated by button 28. A fuse 114 is provided in the power line 102 toprevent undesirable power surges.

The primary 108 coacts with three secondary windings designated 116, 1l8 and respectively. The secondary 116 is in circuit with a lamp 122inside button 28 and a lamp 124 inside button 30. A double throw doublepole maintained contact illuminated pushbutton switch is operated bybutton 30, one of the switch blade contacts being shown at 126 and theother at 128. When the button 30 is pushed in, it simultaneously closesboth contacts 126 and 128 to cause both the lamp 124 and a projectionlamp 130 to glow. The projection lamp 130 is positioned within the unitand provides the illumination for the telescope in the laparoscope atits output connector 36.

The light circuit also includes a pressure-operated switch 132, singlepole double throw momentary contact press to test switch 134 and lamp16. The switch 134 is normally held in engagement with a contact 136 butmay be passed into engagement with contact 138 for a purpose to behereinafter described.

When the button 28 is pushed in to close switch 112, it activates ablower 140 to keep the equipment cool and activates the transformer 110.This also causes the lamp 122 to glow. When the button 30 is pushed in,it closes switch contacts 126 and 128 causing lamps 124 and 130 to glow.Normally, the switch 132 is open and the lamp 16 does not glow. However,when the primary (external) pressure falls below a predetermined minimumvalue, the switch 132 closes and the lamp l6 glows indicating lowprimary gas pressure. if it is desired to test the circuit to determineif the lamp 16 is operative, the switch 134 is moved from contact 136 bypressing pushbutton 32 to contact 138, thereby bypassing the switch 132and causing lamp 16 to glow.

The secondary winding 1 18 is in circuit with a rectitier bridge 142 forchanging AC to DC current. The bridge 142 is in circuit with a relaysolenoid 146 which is operated by a foot-pedal switch 148. When thefootpedal switch 148 is closed, it causes the relay solenoid 146 toenergize which, thereupon, acts to close the solenoid switch 150. Thisenergizes the primary winding 152 of a transformer 154 thereby actuatingthe electrocoagulatory oscillator.

The transformer 154 has two secondary windings 156 and 158. Energizationof secondary 156 causes lamp 32 to glow, indicating activationof theelectrocoagulator oscillator. Energization of secondary 158 sendscurrent through the high voltage rectifier bridge 160 to actuate thehigh frequency oscillator partially comprised of pentodes 162 and 164,whose filaments are in circuit with secondary 120 of transformer 110.The resultant high frequency oscillations pass through transformer 166and through the pre-set range selector switch 34 to the forcepsconnector 46 and in turn to the forceps 42.

The circuit from transformer 166 is completed through the shieldconnector 40. The shield 38 is attached to the patient and by means ofthe shield cable is connected to shield connector 40.

When the operator releases the foot-pedal 48, it opens the switch 148and this inactivates the oscillator circuit. Generally only a momentaryor very short activation time is required.

The invention claimed is:

1. In a laparoscopy system comprising a housing, a gas tank in saidhousing, conduit means connecting said tank to a source of gas underpressure, penetrating means constructed and arranged to penetrate into abody cavity through the abdominal wall, said penetrating means being inselective gaseous fluid connection with said tank and being constructedand arranged to project said gas into said body cavity, and a piercingmeans constructed and arranged to pierce the abdominal wall and passbetween muscle layers under the skin to form a passage into a bodycavity, said piercing means being in selective gaseous fluid connectionwith said tank, the improvement comprising a laparoscope selectivelyinsertable through said passage into said body cavity, said laparoscopecomprising an elongated casing containing a telescope and a forcepsguide tube, said telescope and forceps guide tube extendinglongitudinally of said elongated casing in substantial parallelism witheach other, said telescope being in selective operative connection witha source of illumination in said housing, an elongated flexible forcepsadapted to grasp a fallopian tube, said forceps being selectivelypositioned in said forceps guide tube and extending therefrom in aposition to grasp said fallopian tube while said telescope isilluminated by connection with said source of illumination, whereby saidforceps may be manipulated while said telescope provides an illuminatedview to the operator through the same passage into said body cavity,means connected to said forceps for closing the passage of saidfallopian tube, said laparoscope having means to substantially preventescape of gas from said body cavity when said forceps is not positionedin said forceps guide tube, and said forceps being constructed andarranged to substantially prevent escape of said gas from said bodycavity when it is positioned in said forceps guide tube.

2. The system of claim 1 wherein said means for closing the passage ofthe fallopian tube is an oscillatory electrical current, said currentbeing supplied by an electrical oscillation circuit in said housing, asource of electrical energy operatively and selectively connected tosaid oscillation circuit, said forceps being constructed and arranged toreceive and transmit said oscillatory current from said oscillationcircuit to said fallopian tube, said forceps being in selectiveoperative connection with said oscillation circuit, and means toselectively actuate said oscillation circuit.

3. The system of claim 2 wherein adjusting means are provided in saidoscillation circuit to vary the power output thereof.

4. The system of claim 1 wherein said means for closing the passage ofthe fallopian tube is a clip means.

1. In a laparoscopy system comprising a housing, a gas tank in saidhousing, conduit means connecting said tank to a source of gas underpressure, penetrating means constructed and arranged to penetrate into abody cavity through the abdominal wall, said penetrating means being inselective gaseous fluid connection with said tank and being constructedand arranged to project said gas into said body cavity, and a piercingmeans constructed and arranged to pierce the abdominal wall and passbetween muscle layers under the skin to form a passage into a bodycavity, said piercing means being in selective gaseous fluid connectionwith said tank, the improvement comprising a laparoscope selectivelyinsertable through said passage into said body cavity, said laparoscopecomprising an elongated casing containing a telescope and a forcepsguide tube, said telescope and forceps guide tube extendinglongitudinally of said elongated casing in substantial parallelism witheach other, said telescope being in selective operative connection witha source of illumination in said housing, an elongated flexible forcepsadapted to grasp a fallopian tube, said forceps being selectivelypositioned in said forceps guide tube and extending therefrom in aposition to grasp said fallopian tube while said telescope isilluminated by connection with said source of illumination, whereby saidforceps may be manipulated while said telescope provides an illuminatedview to the operator through the same passage into said body cavity,means connected to said forceps for closing the passage of saidfallopian tube, said laparoscope having means to substantially preventescape of gas from said body cavity when said forceps is not positionedin said forceps guide tube, and said forceps being constructed andarranged to substantially prevent escape of said gas from said bodycavity when it is positioned in said forceps guide tube.
 2. The systemof claim 1 wherein said means for closing the passage of the fallopiantube is an oscillatory electrical current, said current being suppliedby an electrical oscillation circuit in said housing, a source ofelectrical energy operatively and selectively connected to saidoscillation circuit, said forceps being constructed and arranged toreceive and transmit said oscillatory current from said oscillationcircuit to said fallopian tube, said forceps being in selectiveoperative connection with said oscillation circuit, and means toselectively actuate said oscillation circuit.
 3. The system of claim 2wherein adjusting means are provided in said oscillation circuit to varythe power output thereof.
 4. The system of claim 1 wherein said meansfor closing the passage of the fallopian tube is a clip means.